Healthcare Provider Details

I. General information

NPI: 1942118773
Provider Name (Legal Business Name): ROZA SUYUNOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1588 HEREFORD RD
HEWLETT NY
11557-1804
US

IV. Provider business mailing address

1588 HEREFORD RD
HEWLETT NY
11557-1804
US

V. Phone/Fax

Practice location:
  • Phone: 718-551-5124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF360185-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: